I’m looking up at the operating room light, it’s so bright it hurts. It’s hour 18 of my day. I’ve been working since 4am, and now it’s close to 11pm. My neurosurgeon attending is telling me that the surgery will take at least another hour. I’m so tired, and sleepy. In my mind, I go over the things that are not perfect in my life. I start thinking about the rec letters that need to be done, the residency apps, not having enough honors in my third year, maybe I won’t get into my top 3 choices for residency, maybe I picked the wrong career. In my daze and exhaustion, I went over all my inadequacies, and my insecurities.

Then I stopped. There on the OR table is my patient. She is 20yrs old, a college student, riding her bike at 7am that morning. I wondered what she was thinking about, the dreams that she had, if her morning always started off with lots of hope, or a list of things to do. I wondered what she was thinking about as a trolley slammed into her, and threw her off her bike. 2hrs later, she woke up, unable to move anything below her shoulder, but knowing everything. She looked so scared with all those tubes, all the doctors. Her parents are there in the next hour, asking us questions, questions that we don’t want to answer. “can she move again?” “is she going to die?” “why aren’t you guys doing her surgery damn it!”

Medical school teaches us all about science. So technically, she has a complete spinal cord transection at C5. She will be a quadriplegic from now on, if she’s lucky, she’ll breathe on her own. Literature says she has 9yrs more to live with this type of injury, there’s no hope for recovery. She’ll eventually die from an infection, ulcers, or pneumonia. Surgery will stabilize her spine, but will not change her paralysis.

It’s 11:30pm, I’m standing over the table thinking about the imperfections of my life. Yet, my patient will never walk again, write again, breathe on her own again. She will never ride her bike again. Chances are, she will never get married, have a family. She will never get to travel, or use her education. All of this is gone, because of a 2 second impact, a little fracture of that vertebrae.

It’s all about perspective, it’s close to midnight, and I am grateful for my life. For the fact that today, I can breathe, and eat, and walk, and think, and love. Today, I have the ability to still give my all and make a little difference in this world.

I had a really amazing conversation with a resident lately after an attending made me cry. At the end of this conversation, I just really wished I knew these lessons ahead of time. So here they are, for the lovely medical doctors to be following this blog:

1.Confidence

You are not graded on how much you know, but on your confidence. There is no doubt that no matter how well read you are, there are a good 30% of answers you will not know. No matter what, say the wrong answers with confidence. Because if you sound shaky and scared, or hesitant, some residents/attendings will see it as “not knowing” anything at all. They won’t pimp you as much, they’ll start to ignore you or lose interest. Believe me, you need to make an impression to get that wonderful eval. If you don’t have a clue, start reasoning, such as “well, I think a person with hepato-renal syndrome will be hypertensive because…” The idea is not the right answer, but the reasoning and confidence that you deliver your reasoning that matters.

2.Mentors

You will not get along with every resident/attending. I was paired up with a fellow MS3 and we got along with every different people. Our knowledge shined in very different ways. When you find a resident/doctor that think like you, act like you, is the type of professional you’d like to be someday – grab them! A mentor will make a world of difference for you, not to mention you make a new friend in the field.

3.Perspective

This is the big one and the hardest. You will be evaluated subjectively on professionalism, knowledge, when most of it comes down to whether or not they like you and your baking. Constantly working for a “nice eval” or “honors” will burn you out. It also takes the fun out of learning. Instead, choose to see your work in a different light. If you love people, find gratification from the patients. If you love knowledge, choose to find joy in learning new things. Choose a stable aspect of your work that is not subjective and draw your energy from that. Believe me, no matter how spectacular a student you are, you will have horrible days where you feel like an absolute idiot.

For all the medical students, best of luck to you on your future career!!

I enjoyed a beautiful afternoon at the beach yesterday. Although my life is infinitely blessed, I still felt my share of inadequacies and insecurities lately. As I watched the sunset over the horizon, I felt embraced by the love of the infinite designer. I took a picture of the sunset, it wasn’t until afterwards my friends and I found the angel in the sun, complete with its halo. I realized that the reminders of this loving God is all around us, sometimes all it takes is a moment of reflection outside of our own circumstances to see the grandiosity and beauty of His creations.

He’s a really sweet man, he has a family, and grandkids, and he’s lying there with his white hair and beard. On the first day of my inpatient medicine, he taught me how to do the heart exam on him. We saw him everyday, he was our cheerful patient, he will go home in a week. Then one morning, he looked a little sad, we talked and patted his shoulder, telling him to hang in there for us. So…it hurts, like hell, when you type his name into your computer the next morning and the computer pops up with the message “pt deceased at 1630, click ok to continue to records.” He went uroseptic, then shock, without a fever.

He wasn’t the only one to die, I’ve only been on medicine for a few wks, I’ve seen more death than I’ve bargained for.

Patient B has an 8cm cholangiocarcinoma, I stood there watching my attending break the news and watch his daughter’s world shatter in 5min. I watched her crawl into her father’s arms while he comforted her on how this is all “part of life.” How is his cancer part of life?

Patient C has ALS, he was walking and bouncing in July. In October, he can’t move anything. 1 finger means yes, 2 means no. Every morning we have the same question, “are you in pain?” He answers with 2 fingers. Until 2 mornings ago, we spoke with him about “how hospital may not be the best place for him.” Tears came out of his eyes, I’ve never seen a frozen face cry before, and we cried together. The pain is deeper than anything I’ve ever known.

They wrap their bodies in an American flag and we see families say their last good-byes. I once wrote about how much I wanted to be a doctor for the “people.” People is something I was rarely hesitant to open up to, to reciprocate, to let in. Now, I can tell you, I keep a wall between my patients and I. A wall so I can survive medicine, and they can get objective care.

Caption: the blue fish is my resident, the orange one is me, this was literally our faces as we opened the score report today at 12:15pm…oh the horrrorrr

Third year of med school has officially started today. But in reality, it actually started 2 weeks ago when I started my psychiatry rotation. So why did it “officially start today?” Because today I received my Step I score report…and I could NOT believe my score! I PASSED (most importantly), and I got a “happy” score (Thank You Jesus!).

This anxiety-ridden day started at midnight with multiple Facebook status updates and classmates telling me that apparently we are to receive our scores today. I just got off a 16 hour shift, and really wanted some sleep, but after all this updating chats about scores, I almost threw up. Last night was both the shortest and longest of my life. Then this morning I woke up, went back to the psych ward, and hoping that work would cheer me up (clinical medicine has made me so immensely happy about my life the last couple of weeks!). But I was so nervous that despite my lovely patients, I was about to jump out of my skin. Then at 10am, my rotation buddy told me that scores report notifications have been e-mailed, and behold, I got an e-mail! Oh the horror! What if I failed? I can’t cry on the psych ward! Quickly closed e-mail without checking the score.

Toward lunch time, my panic attacks have peaked. I couldn’t feel my hands, my heart was beating next to my thyroid, and my eyes got teary. I couldn’t eat so my resident (aka my boss) told me that we would check the score together. She then mentioned that the deans have paged the students who didn’t pass. I pulled out my little pager, and behold…3 missed pages! OMG! My heart skipped a beat, almost went into A-fib. I quickly scan the messages…none from the deans. Oh God, I was shaking now, and really wanted to pee all the sudden. We opened my e-mail, logged on to the NBME website, I’m about to type in my password….and emergency consult patient shows up (of course they would!). After a 15min chat, patient was diagnosed with anxiety and PTSD (I’m the only one who should be diagnosed with anxiety today). Patient leaves…we open the score report one section at a time…PASS…2##…9#.

I felt like bliss for the rest of the day, on cloud 9, utterly undeserving of God’s amazing grace, and of course for the first time in 2 weeks, I feel like an official third year medical student.

For those who are not in medicine, the USMLE step 1 is the first step of the medical licensing exam that all med students have to take. Students in US take it at the end of their 2nd year of med school. My test day will be on 6/24 (breathe….). It kinda, sorta determines what range of specialties you can potentially get into. It’s a really important test, like the MCAT for med school, or the SAT for college. But unlike those 2 tests, the stuff on the USMLE exams are actually important fundamentals for patient diagnosis and care.

My Step 1 prep has officially started and I am 5 out of 31 days in my schedule. So what does a typical day look like for me?

8am-12:30pm study

1:30pm-3:30pm study

3:50pm – 6:30pm study

6:50pm-8pm study

9pm-11pm study

During this 11 hour study period, I mainly have a one way love affair with my First Aid book, click through about 140 UWorld Questions, drink mountain dew (36mg caffeine/8oz) to stay pumped.

Of course, I have my daily workout squeezed in there. I went home to mommy in LA, mainly for the food (she took me to have Pho tonight). There’s nothing like home cooked meals for board studying.